Examination Unit Application Form for Overseas Candidates
This form is for BHI members who reside outside the UK (overseas) and have already registered or are simultaneously registering for the level of diploma qualification (Level 3, 4 or 5) at which they want to enter exam units in 2017. You can apply to enter examsunits on this form.
You can find information on diploma qualifications and examination units, including the different levels and pathways (mentioned below) on in the Examination Handbook which you can download on our website.
Please print, complete and send this form to Examinations, BHI, Upton Hall, Newark, Nottinghamshire, NG23 5TE, United Kingdom. You can also scan the completed form and email it to , but remember this is a less secure way of submitting your registration.
1. Your details
(please tick one)
☐BHI membership number: ______
☐ I do not know my membership number
Title: ____ First name: ______Other initials: ______
Last name: ______
Following your application, we will communicate with you about the exams, for example to send you exam materials such as theory and practical test papers– please tell us below where you want them sent.
Your contact details
Address: ______
Town: ______Postcode: ______
Country: ______Phone: ______
Email: ______
Please go to the next page.
Where your exam units will take place
Please tell us below where the examinations will take place, eg school, college, invigilator address:
Address: ______
Town: ______Postcode: ______
Country: ______Phone: ______
Email: ______
2. Your unit(s)
I want to enter the following examination units in 2017:
(pleasetick as appropriate, you pay £120.00 per unit)
☐D1: The Theory of Clock and Watch Servicing (Theory Examination)
☐D2: Constructing Clock Components (Practical Test Piece)
☐ D3: Servicing and Correcting Faults in a Single Train Clock Movement (Servicing Test)
☐ D4: Servicing and Correcting Faults in a Quartz Watch (Servicing Test)
☐D5: Constructing Clock and Watch Components (Practical Test)
☐D6: Drawing Clock/Watch Escapements
☐D7: The Practical Servicing of Clocks (Record of Repairs)
☐D8: The Recoil Escapement, Design and Construction
☐D9: Servicing and Correcting Faults in a Striking Clock Movement (Servicing Test)
☐D10: The Practical Servicing of Complex Clocks (Record of Repairs)
☐D11: The Theory of Complex Clocks & their Repair, Restoration and Conservation (Theory Examination)
☐D12: The Dead Beat Escapement, Design and Construction (Practical Test Piece)
☐D13: The Practical Restoration and Conservation of Clocks (Portfolio)
☐D14: The Practical Servicing of Quartz and Mechanical Watches (Record of Repairs)
☐D15: Servicing and Correcting Faults in a Manual Winding Watch Movement (Servicing Test)
☐D16: Servicing and Correcting Faults in an Automatic Watch (Servicing Test)
☐D17: The Practical Servicing of Complex Watches (Record of Repairs)
☐D18: The Theory of Complex Watches & their Repair, Restoration & Conservation (Theory Examination)
☐D19: The Practical Restoration and Conservation of Watches (Portfolio)
☐D20: Servicing and Correcting Faults in a Chronograph Movement (Servicing Test)
Please go to the next page.
I have the following particular assessment requirements (see Examination Handbook):
(please tick where appropriate and enclose supportive information)
☐ None
☐ Physical or mental disability
☐ English as a second language
☐Other, namely: ______
3. Your invigilator's details(see Examination Handbook)
Please tell us who you suggest as your invigilator and give us his or her details, including an email address where we can contact him or her. Please note: it may be necessary to send examination materials by Registered/Signed For post to the Invigilator’s address:
First name: ______Last name: ______
Home: ______
Town: ______Postcode: ______Country: ______
Phone: ______Email: ______
My suggested invigilator is:
(please tick one and complete)
☐ A Justice of the Peace or the equivalent (give details): ______
☐An accredited member of the BHI (MBHI or FBHI) with BHI membership number: ______
☐A teacher in a recognised educational establishment, namely: ______
☐Another, namely (give details of qualification or status): ______
Please go to the next page to complete this form and give us your payment details.
4. Your payment
I will pay the following.
Unit(s) fee
I have selected ___ (your total number of units in 2017) units at £120.00 per unit: £ ______
Deposit
I have selected the following units, for which I pay a (returnable) deposit of £60.00 per unit:£ ______
(please tick and add the sum where appropriate)
☐Unit D3 at £60.00:£ ______
☐Unit D4 at £60.00:£ ______
☐Unit D15 at £60.00:£______
Materials for making a practical test piece
(you can order a small pack of materials consisting of brass, carbon steel or gauge plates,
please note that this does not include tools)
I order ___ (the number of packs you want) materials for Unit D2 at £15.00 per pack:£ ______
I order ___ (the number of packs you want) materials for Unit D5 at £15.00 per pack:£ ______
I order ___ (the number of packs you want) materials for Unit D12 at £15.00 per pack:£ ______
Additional jewel(s)
I am aware that I will be provided with a jewel for Unit D5, nevertheless
I order ___ (the number of additional jewels you want) additional jewels at £5.00 per jewel:£ ______
------
Total:£ ______
I will pay the above total as follows:
(please tick one and complete where necessary)
☐ I enclose a cheque in UK £ sterling made payable to ‘BHI Ltd’
☐ I want to pay with my debit card (please give card details below)
☐ I want to pay with my credit card and I understand you will add a 3% credit card surcharge (please give card details below)
Name on card: ______Card number: ______
Expires:_____ Security code (last three digits): ____
First line of the billing address: ______
1
British Horological Institute Ltd Upton Hall Newark Nottinghamshire NG23 5TE United Kingdom Phone: +44(0)1636 813795 Facsimile: +44(0)1636 812258
Company Registration Number: 0013 0649 VAT Registration Number: GB 598546473